Probing the depression-rumination cycle

Why chewing on problems just makes them harder to swallow.

By
BRIDGET MURRAY LAW

Monitor Staff

November 2005, Vol 36, No. 10

Print version: page 38

The word "ruminate" derives from the Latin for chewing cud, a less than gentile process in which cattle grind up, swallow, then regurgitate and rechew their feed. Similarly, human ruminators mull an issue at length.

But while the approach might ease cows' digestion, it doesn't do the same for people's mental health: Ruminating about the darker side of life can fuel depression, said Yale University psychologist Susan Nolen-Hoeksema, PhD, in a Board of Scientific Affairs invited address at APA's 2005 Annual Convention.

What's more, rumination can impair thinking and problem-solving, and drive away critical social support, she said.

In work published in APA's Journal of Personality and Social Psychology, JPSP (Vol. 77, No. 4, pages 801-814), Nolen-Hoeksema and Christopher Davis, PhD, found that although ruminators report reaching for others' aid more than nonruminators, they receive less of it. In fact, many of them report more social friction--"things like people telling them to buck up and get on with their lives," said Nolen-Hoeksema.

People might respond to a ruminator compassionately at first, but their compassion can wear thin if the rumination persists.

"After a while they get frustrated, and even hostile, and start pulling away, which of course as a ruminator gives you a whole lot more to ruminate about: 'Why are they abandoning me, why are they being so critical of me?'" said Nolen-Hoeksema.

In her talk, she explored the roots of this cycle of rumination and depression, and what can be done to break it.

The rumination-depression link

Numerous longitudinal studies point to rumination's negative effects: For example, research Nolen-Hoeksema conducted on Bay Area residents who experienced the 1989 San Francisco earthquake found that those who self-identified as ruminators afterward showed more symptoms of depression and post-traumatic stress disorder.

Another of her studies, conducted with Judith Parker, PhD, and Louise Parker, PhD, found rumination predicted major depression among 455 18- to 84-year-olds who had lost family members to terminal illnesses. Those who ruminated more often became depressed, and stayed depressed in follow-ups through 18 months later, according to the study, published in 1994 in JPSP (Vol. 67, No. 1, pages 92-104).

In addition, a community survey Nolen-Hoeksema conducted on 1,300 adults, ages 25 to 75, backed those results. It found that ruminators develop major depression four times as often as nonruminators: 20 percent versus 5 percent. (The results were significant even for ruminators who weren't depressed at baseline.)

Many ruminators stay in their depressive rut because their negative outlook hurts their problem-solving ability, said Nolen-Hoeksema. According to her research, they often struggle to find good solutions to hypothetical problems. For example, if a friend is avoiding them, they might say, "Well, I guess I'll just avoid them too."

In addition, ruminators express low confidence in their solutions and often fail to enact them--for example, failing to join a bereavement support group despite intending to, said Nolen-Hoeksema.

"Even when a person prone to rumination comes up with a potential solution to a significant problem, the rumination itself may induce a level of uncertainty and immobilization that makes it hard for them to move forward," she said.

Why people ruminate

Such depressive rumination most often occurs in women as a reaction to sadness, according to research Nolen-Hoeksema conducted with Lisa Butler, PhD, of Stanford University. Men, by comparison, more often focus on their emotions when they're angry, rather than sad, she said.

The reason, Nolen-Hoeksema speculated, is largely cultural.

"There are differences between what it's OK for women versus men to focus on emotionally," she said.

Gender aside, ruminators share some common characteristics. They often:

Believe they're gaining insight through it.

Have a history of trauma.

Perceive that they face chronic, uncontrollable stressors.

Exhibit personality characteristics such as perfectionism, neuroticism and excessive relational focus--"a tendency to so overvalue your relationships with others that you will sacrifice yourself to maintain them, no matter what the costs," Nolen-Hoeksema explained.

Bucking rumination

It's hard to divert depressive ruminators from their negative thoughts, Nolen-Hoeksema's research indicates. However, distracting them by directing them to think about, for example, a plane flying overhead, the layout of their local mall or a fan slowly rotating, does appear to decrease their rumination. Her studies with Sonja Lyubomirsky, PhD, of Stanford University--many of them published in JPSP--have found that distracted ruminators less often recall negative events, such as being dumped by a significant other, than nondistracted ruminators. Distraction also helps mitigate ruminators' tendency to focus on problems--and express self-blame and low confidence--when discussing their lives, the research suggests.

Practically speaking, people can use such distraction techniques as meditation and prayer to help break the rumination cycle, said Nolen-Hoeksema. Other cycle breakers she suggested include:

Taking small actions to begin solving problems.

Reappraising negative perceptions of events and high expectations of others.

Letting go of unhealthy or unattainable goals and developing multiple sources of self-esteem.

"For example, women who build their identity soley around family are rumination-prone" because they've got all of their self-esteem and social support in one basket, said Nolen-Hoeksema. "So helping them to develop multiple sources of gratification and social support can be helpful buffers against stressful events in any one of those domains."